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15 Derma > Bacterial Skin Infections > Flashcards

Bacterial Skin Infections Flashcards

1
Q

etiology of impetigo

A

s aureus or s pyogenes

  • dirty fingernails
  • other children
  • day care centers
  • crowded housing areas
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2
Q

skin findings in non-bullous impetigo

A
  • sites: face or extremities after trauma

- papules -> vesicles -> pustules -> rupture -> honey colored crusted papules on erythematous base

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3
Q

skin findings in bullous impetigo

A
  • flaccid bullae
  • ruptured bullae leave circinate, weepy or crusted lesions
  • sites: face, extremities, perineum
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4
Q

management of impetigo

A
  • proper hand washing
  • clean lesion with soap and water
  • fomite control
  • topical or oral antibiotic: mupirocin 2% ointment, fusidic acid
  • widespread and deeper lesions: systemic antibiotics + topical therapy (dicloxacillin or cephalexin, erythromycin, coamoxiclav)
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5
Q

drugs for mrsa

A

doxycycline, clindamycin, cotrimoxazole

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6
Q

prevention of impetigo if recurrent

A
  • nasal decolonization with mupirocin ointment daily for 5-10 days
  • body decolonization with chlorhexidine for 5-14 days
  • bleach bath 2x weekly for 3 mos
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7
Q

etiology of ecthyma

A

staphylococcus and/or streptococcus

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8
Q

skin findings in ecthyma

A
  • ulcerative pyoderma that extends deep into dermis
  • punched out ulcers with thick grayish yellow crust, erythematous elevated borders
  • superficial saucer shaped ulcer with raw base and elevated edges
  • heal with scarring
  • site: lower extremities
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9
Q

predisposing factors to ecthyma

A

poor hygiene, malnutrition, trauma, diabetes

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10
Q

treatment for ecthyma

A
  • clean with soap

- topical or oral antibiotics (mupirocin ointment, oral dicloxacillin, 1st gen cephalosporin)

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11
Q

an acute, round, tender, circumscribed perifollicular abscess that ends in central suppuration

A

furuncle in furunculosis

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12
Q

what are carbuncles

A
  • extremely painful lesion at the nape, back, or thighs

- deeper inflammatory lesion when furuncles coalesce

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13
Q

skin findings in carbuncles

A
  • red and indurated, multiple pustules, drains externally around multiple hair follicles
  • yellow gray irregular crater at center
  • heals with scarring
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14
Q

etiology of furunculosis and carbunculosis

A

s aureus

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15
Q

course of carbuncles and furuncles

A
  • central necrosis -> rupture -> purulent discharge + necrotic debris
  • sites: nape, axilla, buttocks, thighs
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16
Q

treatment for furunculosis and carbunculosis

A
  • early stage: warm compress + antibiotic
  • fluctuant: incision and drainage
  • handwashing, chlorhexidine wash, bleach bath
17
Q

etiology of cellulitis

A

gabhs and s aureus

18
Q

skin findings in cellulitis

A
  • ill defined erythema and edema, warmth and pain of affected area
  • bulla formation and superficial necrosis -> epidermal sloughing or erosions
  • site: lower extremity, UNILATERAL
19
Q

risk factors and labs for cellulitis

A
  • rf: disrupted skin barrier (toe web infection), immunocompromised, age, obesity, renal or hepatic disease
  • leukocytosis >/= 10,000, elevated esr, elevated crp
20
Q

management of nonpurulent cellulitis

A
  • first line: cephalexin, dicloxacillin, penicillin v

- second line: clindamycin, macrolides

21
Q

management of purulent cellulitis

A
  • incise and drain, culture
  • mssa: cephalexin, dicloxacillin
  • mrsa: clindamycin, tetracycline, tmp-smx
22
Q

treatment duration of cellulitis

A
  • uncomplicated: 5-10 d
  • immunocompromised: 7-14 d
  • reassess after 24-72 hr
  • treat predisposing factors
23
Q

indications for parenteral antibiotics in cellulitis

A

at least 2 or more:

  • t >38C or <36 C
  • pr >90 bpm
  • rr >20/min
  • wbc >12,000 or < 4,000
  • failed outpatient treatment
24
Q

etiology of erysipelas

A

gabhs/gc/gg

25
Q

skin findings in erysipela

A
  • sharply marginated, deep red, edematous plaques
  • painful and warm
  • site: superficial dermal lymphatic vessels of leg
  • erythematous patch -> peripheral extension
26
Q

clinical findings in erysipelas

A
  • preceded by fever, chills, vomiting, joint pains

- leukocytosis >20,000

27
Q

complications of erysipelas

A

septicemia, deep cellulitis, necrotizing fasciitis, abscess

28
Q

ddx for erysipelas

A

contact dermatitis, lupus erythematosis

29
Q

treatment for erysipelas

A
  • uncomplicated: oral antibiotics (penicillin v, amoxicillin, clindamycin, macrolides)
  • leg elevation, ice bags, cold compress
  • treat predisposing factors

improvement in 24-48 hrs, 10 days for skin

30
Q

etiology of green nail syndrome

A

p aeruginosa

- hands frequently submerged in water

31
Q

nail findings in green nail syndrome

A
  • onycholysis
  • green discoloration of distal portion of nail
  • paronychia
32
Q

treatment for green nail syndrome

A
  • 1% acetic acid soln
  • neosporin
  • keep hands dry, avoid trauma
33
Q

how to get pseudomonas folliculitis

A

contaminated baths in the past 2 weeks

34
Q

skin findings of p folliculitis

A
  • sudden onset pruritic follicular, maculopapular, vesicular, pustular lesions
  • 1-4 days after bath
  • sites: sides of trunk, axillae, breasts, buttocks, proximal extremities
35
Q

management of p folliculitis

A
  • self-limiting within 7-14 days

- fever and constitutional symptoms: 3rd gen cephalosporin or fluoroquinolone (ciprofloxacin or ofloxacin)

36
Q

etiology of pyogenic paronychia

A

s aureus

37
Q

skin findings in pyogenic paronychia

A
  • painful, tender, red swelling of skin surrounding fingernail
  • can progress to abscess
  • primary disposing factor: separation of cuticle from nail plate
38
Q

management of pyogenic paronychia

A
  • keep nails dry, gloves
  • incision and drainage
  • suppurative = oral antibiotic: penicillin or cephalosporin

15 Derma (7 decks)

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